More than one third of people admitted to the hospital are older people. And at any time, almost half of people in the hospital are 65 or older. Almost half of older people seen in an emergency department are admitted to the hospital.
When many older people leave the hospital, they may be in worse shape than before they became ill. Part of the reason for the decline is that older people tend to have longstanding serious and debilitating disorders when they enter the hospital. (See also Problems Due to Hospitalization Problems Due to Hospitalization Just being in the hospital can cause certain problems, particularly infections (called hospital-acquired infections). Other problems include Problems associated with extended bed rest, including... read more .)
However, part of the reason is just being in a hospital, which can cause problems, regardless of age. Older people are more likely to already have or to develop these problems, and the consequences are more likely to be serious for the following reasons:
Confusion: Changes that occur as people age make them more likely to become suddenly and noticeably confused (delirious Delirium Delirium is a sudden, fluctuating, and usually reversible disturbance of mental function. It is characterized by an inability to pay attention, disorientation, an inability to think clearly... read more ).
Dehydration: Older people tend to feel thirsty less quickly or less intensely than younger people. They thus are inclined to drink less, especially when circumstances make getting water more difficult, as occurs in a hospital.
Falls Falls in Older People Most falls occur when older people with one or more physical conditions that impair mobility or balance encounter an environmental hazard. Although many people have no symptoms before a fall... read more : Older people are more likely to fall and, if they fall, more likely to have a serious injury such as a broken bone.
Incontinence: Older people may have particular difficulty getting out of a high hospital bed after they have had surgery, when they have a serious disorder, or when they have various equipment attached to them. As a result, they may not get to a toilet in time.
Loss of independence: During a hospital stay, older people may become unable to take care of themselves because staff members provide this care (such as bathing).
Loss of muscle tissue: When they spend a lot of time in bed or are immobilized, older people tend to lose more muscle tissue and lose it more quickly.
Pressure sores Pressure Sores Pressure sores are areas of skin damage resulting from a lack of blood flow due to prolonged pressure. Pressure sores often result from pressure combined with pulling on the skin, friction,... read more : Older people are prone to pressure sores because they tend to have less fat under the skin and blood flow to the skin is decreased. If they develop pressures sores, they may be sent to a nursing home rather than their own home after they are discharged from the hospital.
Side effects of drugs: Before entering the hospital, many older people are taking several drugs (see also Aging and Drugs Aging and Medications Medications, the most common medical intervention, are an important part of medical care for older people. Without medications, many older people would function less well or die at an earlier... read more ). In the hospital, more drugs may be prescribed. The more drugs people take, the greater the chance for side effects and drug interactions. Also, older people are more sensitive to the effects of certain drugs.
Undernutrition Undernutrition Undernutrition is a deficiency of calories or of one or more essential nutrients. Undernutrition may develop because people cannot obtain or prepare food, have a disorder that makes eating or... read more : Physical age-related changes may reduce appetite or absorption of nutrients, as may certain disorders (including dental problems) and drugs.
Many older people have difficulty bouncing back psychologically and physically from the experience of being in a hospital as well as from the disorder they have had.
Some hospitals have developed strategies to prevent problems that can result when older people are hospitalized. These strategies are designed to help older people continue to function as well as they did before they became ill.
An interdisciplinary team Interdisciplinary care Providing medical care to older people can be complicated. People often have many different health care practitioners at different locations. Travel and transportation issues become more difficult... read more : This team consists of health care practitioners who work together to care for an older person. Team members evaluate the person’s needs and coordinate the person’s hospital care. Team members look for possible problems and correct or prevent them.
A one-focus team: This team focuses on preventing and managing one specific problem, such as undernutrition or pressure sores. Such teams are often led by a nurse, who checks the person for the problem and develops a care plan.
Geriatricians: These doctors are trained specifically to care for older people and can help prevent problems common among them. For example, geriatricians avoid prescribing drugs that are particularly likely to cause problems in older people and may stop drugs that have minimal benefit or potential side effects (see also Aging and Drugs Aging and Medications Medications, the most common medical intervention, are an important part of medical care for older people. Without medications, many older people would function less well or die at an earlier... read more ).
Guidelines: Hospitals may also follow guidelines for care (protocols) developed specifically for older people.
An assigned nurse: Sometimes one nurse is assigned to have primary responsibility for and to monitor a person’s care. This nurse makes sure that other staff members understand the treatment plan for the person.
Geriatric nursing units: These units are designed for older people and staffed with people trained in caring for them. In these units, older people are encouraged to get out of bed as soon and as much as possible. They are encouraged to dress each morning, to follow their usual daily routine as much as possible, and to eat in a group dining room. If older people are going to be in the hospital a long time, they are encouraged to personalize their room with photographs, pillows, and other familiar items. Staff members encourage family members and friends to participate in care.
How aggressively a disorder is treated in a hospital should not depend on age. Family members and older people should talk with a doctor to make sure options for treatment are based on the severity of the disorder, not on age. However, less aggressive treatments are sometimes appropriate for older people, depending on their wishes and outlook—that is, how the disorder is expected to progress and how long they are expected to live. Having advance directives Advance Directives Health care advance directives are legal documents that communicate a person’s wishes about health care decisions in the event the person becomes incapable of making health care decisions. There... read more , which state what sort of care people want, is particularly important for older people.